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Monday, November 11, 2013

What Restorative Materials Are Best?

Restorative materials have traditionally led the charge in changing the way in which dental patients are treated. Composite resin had largely supplanted the older silicate restoration by the early 1970s, as a result of its superior durability and aesthetics. Today, we are witnessing a worldwide shift away from amalgam restorations. Amalgams are durable, easy to place, and safe when properly prepared and placed. But can they continue to be used in the face of the public's growing fear of "mercury fillings"? Neither metallurgical science, nor a century of data showing amalgam restorations to be generally safe and cost-effective, means much to antiamalgam activists, not all of whose claims can be dismissed as irrational. Some concerns are valid, such as the environmental impact of residual mercury in improperly mixed amalgam.

From the patient's viewpoint, most would agree that amalgam is not the best aesthetic choice, especially for anterior teeth, and some patients refuse amalgam for that reason alone. Tooth-colored resins, although the technology has advanced regularly and spectacularly, aren't always a satisfactory substitute. They require more attention to technique, their cost is generally higher, and they typically must be replaced more frequently over the patient's lifetime. This not only costs more but also exposes the patient to more of the risks, however minimal, associated with restorative dentistry.

In the case of amalgam, I see the choice of restorative material being based increasingly on preference rather than evidence. The preference could be that of the individual patient (which we have seen evolving in the United States) or that of the electorate, implemented by government fiat. On the other hand, environmental issues could ultimately trump all others.